Provider Demographics
NPI:1720178700
Name:MORGAN, SHELLY ANN (PMH-NP)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:ANN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PMH-NP
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:ANN
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMH-NP
Mailing Address - Street 1:707 BROADWAY BLVD NE STE 400
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2366
Mailing Address - Country:US
Mailing Address - Phone:505-268-0701
Mailing Address - Fax:
Practice Address - Street 1:707 BROADWAY BLVD NE STE 400
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2366
Practice Address - Country:US
Practice Address - Phone:505-268-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN168191163W00000X
MER050690363LP0808X
MEAP081793363LP0808X
AZAP4020363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432307199OtherMAINECARE